Empathy

Empathy is a very important part of my role as a therapist. Without it, the therapy relationship would feel and even be, robotic, mechanistic. What makes therapy human, connected, real, interesting and therefore valuable to the client (and me) is my ability and willingness to try to imagine what it would be like to be my client, as they are, in their situation. This is what makes empathy different from compassion, as I define those terms. Compassion exists when we say to ourselves “I feel bad for that person because they are… (in a bad situation, etc.).” Empathy exists when we say to ourselves, “I know what it is like to be in that person’s situation and can imagine how it would feel to be in that situation.” In therapy, I try to take this a step further, knowing full well it isn’t really possible. Like I said above, when I empathize with a client as their therapist, I am trying to imagine what it would be like to be in their situation, with the added element of imagining what it would be like to be them (not me)in their situation.

This is more difficult than it might seem. In order to really be able to imagine what it would be like to be someone else in any variety of situations, you have to really know and understand someone. People are complicated. No matter the context in which you meet someone, it takes a while to get to know a person. When that person is a client in therapy, they want to be known, by me, the therapist. So, they are nearly always far more open and candid than they would be if they were not in a therapy session. Still, trying to imagine what it would be like to be someone else, especially when that someone is suffering from some kind of serious emotional turmoil (as they are in therapy) is difficult, but necessary. Clients often tell me that to trust a therapist, they have to conclude their therapist “gets it,” which I take to mean that they feel known and understood by the therapist, that the therapist “gets” what it would be like to be them in their situation.

Why is empathy as I describe it essential to therapy? If a client doesn’t think their therapist can imagine what it would be like to be them in their situation, how can the client believe the therapist really understands their problems, their unique and valid difficulty resolving their problems, and how to help them solve problems they have not been able to solve themselves. Without this trust, I don’t think clients can accomplish much of anything in therapy. I am not alone in coming to this kind of conclusion. In graduate school, we read a book that reached a similar conclusion. The book is called “Escape from Babel: Toward a Unifying Language for Psychotherapy Practice” (written by Duncan, Hubble and Miller in case you are interested in buying the book). It is a “meta-study” (a study of other studies) about what makes therapy successful. The rapport between a client and their therapist is the second most important factor for success in therapy (second only to the client’s level of motivation for change). In other words, does the client feel a connection to therapist such that they believe their therapist “gets it” (understands the client and their problems)? If the answer is yes, therapy stands a much greater chance of success. Oh, and by “success,” I mean the client thought the therapy was valuable in helping them achieve their goals.

Another interesting point came out of the meta-study in Escape From Babel: the kinds of “techniques” used by the therapist were far less important to success in therapy than the relationship the client and therapist were able to form. Prior to reading this book and being in graduate school to become a therapist, I had been a therapy client with several different therapists using many different approaches. When I read that conclusion in Escape From Babel, I knew it to be true from my own experience. I don’t mean to suggest that therapeutic approaches are completely unimportant. They are just less important than the connection between the therapist and client. Put another way, in my experience, and as implied in the book, no matter what approach a therapist might take, and how good they are at implementing that approach, if the client doesn’t feel a connection to the therapist on a basic human level, chances for success are not great, especially if the therapy work that needs to be done runs pretty deep and can’t be resolved in a few sessions.

Where does empathy come from? In general human terms, we are born with the capacity to empathize (except in very rare circumstances). Our willingness to cultivate empathy depends on how safe we feel within ourselves and in our relationships. The more secure we are with who we are, the more we will be able to move past ourselves to reach out to others, not just to care about them, but to get to know them at a deep enough level that we can imagine being like them. It might be easier to put myself in an empathetic state in therapy because I feel secure as a therapist most of the time. I am able to risk the emotional vulnerability that comes with empathy in therapy because I know empathy is a central and basic need my clients seek in therapy and I trust my ability to “be them” in my mind while also staying grounded in myself so I can simultaneously “see them” from my perspective.

As a therapist, I am always asking myself questions like this: “based on what I know about David, would he have the ability to recognize his unconscious motivations for the way he reacted to his boss in the story he is telling me?” I then imagine being David in an argument with his boss, who is a woman. I imagine what it must be like for David to have a boss that reminds him of the wife that just left him, taking the kids with her. His boss doesn’t know this, and therefore may have no idea why David reacted so disproportionately to her criticism of his work, which, while seemingly unreasonable, didn’t warrant David’s vehement response. I come to the preliminary conclusion that David may not have understood his own reasons for reacting so strongly (in the session, he is aggressively describing the negative personality traits of his boss). I ask him if his boss sometimes reminds him of his wife. He disagrees, says they don’t look or act anything alike. I then compare criticisms his wife had given him before she left (which he had told me in previous sessions), which are fairly similar to those his boss recently leveled against him. He recognizes the connection, starts to talk about how he fears his boss will fire him, in much the same way his wife did. He tells me he fears going through the grief and loneliness of his divorce all over again if he is now fired. David cries a little, and so do I. We share memories of the pain he experienced and expressed in previous therapy sessions leading up to and through his divorce.

David now has a better understanding of his own emotional landscape. David’s ability to trust me is also sustained because he could see me trying to imagine being him in his argument with his boss after going through the recent and painful divorce. It is precisely because David trusts my understanding of his pain and anguish that he is able to listen to my suggestion that his emotional reaction to his boss might have been misplaced, or at least exaggerated. He decides to tell his boss what he has learned about his reaction, hoping that, by letting her know, she may be willing to let go of any residual resentment she feels for the way he reacted. David can do this without expecting her to recant her criticisms because he understands how he needs to change, regardless of whether anyone else around him (including his boss) changes.

Empathy is vital to therapy. Yet, empathy is also very much one-sided in therapy. I empathize with my clients, actively, regularly, and out loud. I do not expect or want my clients to try to empathize too much with me. A little bit is good because I am after all not just a therapist. I am a man. At a minimal level, when I expect a client’s consideration of my needs, this can be good role modeling for a client to step outside of herself or himself. Beyond that, expecting or allowing a client to become too empathetic to a therapist’s needs can get in the way of the client’s ability to stay focused on their issues, so I try to contain it to a modest level. We are, after all, in therapy to meet the client’s emotional needs, not mine. If I need empathy to the extent I want it from my clients for my own emotional needs, I will find my own therapist.

Empathy is clearly not just important in therapy; it is important for all of us because it teaches us how to be more flexible, adaptable, and to predict how we can improve our relationships with others. It must, because empathy requires us to step outside of ourselves (in our imagination) and remove from our considerations (as best we can) what we would do, and instead focus on understanding why others do what they do. When we read a book, watch a movie or play, or listen to a friend tell us about characters, relationships, and behaviors that are foreign to us, yet capable of being understood, we grow as people because we try to imagine what it would be like to be those characters in those relationships, engaging in those behaviors. If this were all there were to empathy, it would be little different than fantasizing about how others live their lives. Empathy comes into play when the thing we are imagining is difficult, difficult and painful for the person(s) in the situation, and difficult for us to truly comprehend their situation—because it causes us to feel something like the pain we imagine they feel. Yet, we do it anyway, despite the discomfort, the pain. We do it because we care; we care about that person, or at least care about their situation, and want to help them get out of their situation. This is also what makes empathy more compelling than compassion. Compassion tells us to care about the suffering of others, which is beautiful. Empathy goes further, and tells us to force or allow ourselves to experience something like the experience we imagine others feel, even when that is painful, difficult, and avoidable.

The difference between compassion and empathy is illustrated by a compelling parable told on the TV show, The West Wing. I saw it quite a while ago, so the details are fuzzy, but it goes something like this (truth be told I might be unwittingly modifying it a bit): A guy finds himself down in a hole and can’t get out. He yells to a stranger walking by, “Hey can you help me get out of here?” The stranger says as he keeps walking, “I feel for you down there, but there’s nothing I can do.” A priest walks by, the guy in the whole says, “Hey Father, can you help me get out of this hole?” The Priest says, “I will say a prayer for you.” The Priest keeps walking. Then a friend walks by, sees his friend down in the hole, jumps down into the hole. The guy in the hole says, Why’d you do that, now we are both down here and are both stuck.” The friend says, “I’ve been down here before, and I came down to show you the way out.” The stranger and priest show limited compassion. The friend shows empathy by “being with” his friend down in the hole.

Empathy is such a good thing, it is difficult to imagine when we should not empathize with others. All that comes to mind is limiting empathy when we ourselves feel nearly overwhelmed, or when our empathy is being exploited, as in a co-dependent or abusive relationship. If empathy is such a good thing, then why is it not as common as it seems it should be? I have two thoughts on this. First, true empathy is difficult, even emotionally draining at times. It is even more difficult if we don’t really know ourselves very well. We can’t really imagine what it would be like to be someone else in a given situation if we don’t know and understand them pretty well. How can we expect to truly understand someone if we don’t know ourselves? We can’t. So, empathy requires self-knowledge, compassion, and a willingness to risk emotional vulnerability within ourselves, so we can stay “grounded” within ourselves while also reaching out emotionally to “be where they are.”

The connection between a client and therapist can run very deep if there is adequate understanding, vulnerability and risk taking on both sides. The benefits of successful therapy are amazing, truly amazing. I say this both as a therapist and as a previous therapy client who knows from both sides what success in therapy can mean. So, if empathy in the context of therapy, where it is almost completely one-sided ( the therapist empathizes with the client, but not the other way around) is so important, just imagine what the benefits are for having deep and genuine empathy in a two-sided relationship, like with a good friend, your partner, sister, or colleague.

Real empathy also requires a good dose of humility. Humility means that we realize that we have limits, we are not necessarily any more important than anyone else. As I’ve said in other writings, humility to me means “I am just some guy.” If I want to be genuinely empathetic, I have to be able to tell myself, “I could have ended up being just like this person, in their situation, even though I am not, which means I am no better than they are.” Only then can we really imagine what it would be like if we were in fact just like that person, in their situation. Once we are on their level, whomever they are—spouse, co-worker, sibling, friend, stranger—we can much more easily relate to their experience and allow ourselves to be truly connected to them and their situation. What if you could bring deep and genuine two-sided empathy to all of your important relationships? You can. And I hope you will for your sake and for theirs.